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Code Red Powerpoint REVISED


									            Code Red

          Kenneth I. Shine, M.D.
Executive Vice Chancellor for Health Affairs
     The University of Texas System
      Access to Health Care in Texas
• CODE RED: The Critical Condition of Health Care in
  Texas, a report by the Task Force Access to Health Care in
  Texas: Challenges of the Uninsured and Underinsured.
• Sponsored by the 10 major Texas academic health
  institutions – Baylor College of Medicine, Texas Tech,
  Texas A&M, North Texas and the six health institutions of
  The University of Texas System.
• Membership includes representatives from large and small
  employers, hospitals, medical schools, health policy
  experts, and community leaders.
Task Force Members
    Neal Lane – Chair
  John Stobo - Vice Chair
     Hector Balcazar
      Kirk Calhoun
     David Chappell
     Patrick Crocker
      Charles Haley
    George Hernandez
      Winell Herron
      Rich Johnson
                               Task Force Members
                                     Wm. Fred Lucas
                                    Michael McKinney
                                      Kathy Mechler
                                     Elaine Mendoza
                                    Rob Mosbacher*
                                     Steve Murdock
                                     Betsy Schwartz
                                      David Warner
                                      M. Roy Wilson
* Resigned as of October 18, 2005
       Current Conditions in Texas
• 25.1% of Texans or 5.6 million were without health
  insurance in 2004 – one out of every four.
• 15.7% or 46 million Americans were without health
  insurance in 2004.
• The problem will increasingly worsen as the
  population in Texas increases from 22 million in
  2003 to a projected 51.7 million in 2040.
          Who are the Uninsured?
• 79% of uninsured adults in Texas work or are
  members of families where someone works.
• Only 37% of small employers (less than 50
  employees) offer health insurance and only 35% of
  their employees actually enroll.
• For a family of four at the federal poverty line
  ($20,000 a year), the average cost of health
  insurance is $9,100 – almost half their income.
          Who are the Uninsured?
• Many adults do not qualify for Medicaid in Texas.
• Medical Indigence in Texas is currently defined as
  those living at or less than 21% the federal poverty
  line – less than $1700 a year for a single adult.
• The State Children’s Health Insurance Program
  covers children who make at or less than 200% the
  federal poverty line, but their parents are not
• Poorer Health status
• Affects education and work status
• Damage to community resources such as hospitals
  and emergency rooms
• Family disruptions including bankruptcies
• Higher health care costs borne by those who do
  have insurance
• Rising tax burdens and less attractive business
• The overall health status of Texans is poor.
• Texas has the highest proportion of uninsured individuals in the
  United States.
• Strategies to control the cost of health insurance are needed.
• Current trends in the delivery of health care will exacerbate
• Emergency rooms provide an expensive method for providing care.
• Texas communities are making great efforts to improve access to
  health care.
• Expansion of ambulatory (outpatient) services is an essential.
• The continuing rise in Medicaid and health care expenditures is
• The state of Texas has not taken full advantage of federal matching
• The current county based approach to health care in Texas is
  inadequate and inequitable.
• There is a significant shortage of health care professionals in Texas.
• Educational attainment and health are inexorably linked in Texas.
• Care of people with mental illness remains a major unresolved
  problem for Texas.
• The solution to adequate access to health care for the uninsured and
  underinsured is a shared responsibility where partnerships are
           Shared Responsibilities
• The Task Force concluded that solutions to the
  challenge of the uninsured must arise out of a
  shared responsibility for the problem by a broad
  diversity of participants.
• Additional resources and the more efficient and
  effective use of resources will be required in order
  to provide appropriate services to the uninsured.
        Recommendation 1

Texas should adopt a principle that all
individuals living in Texas should
have access to adequate levels of
health care.
         Recommendation 2
Texas should provide more adequate
resources and aggressively seek more
efficient and effective methods to support
health care to the indigent and uninsured
with the goal of reducing rising health
care costs.
         Recommendation 2 (Cont.)
•   Move to Regional/Multi-County Care
•   Increase Eligibility from 21 to 100% of FPL
•   Aggressively Pursue Federal Funding
•   Improve Tax Policies
•   Prefer Contractors and Subcontractors for
    Government Contracts Who Provide Health Care
          Recommendation 3
A Quality Assurance Fee (called a provider
tax in some states) of 3% should be assessed
on revenues of all hospitals and free standing
surgery centers in order to obtain a federal
match to enhance overall finances for provider
reimbursement and enhancement of the
quality and efficiency of health care to the
          Quality Assurance Fee
• 35 States have quality assurance fees.
• All classes of providers will be impacted (e.g.
  hospitals, and surgicenters).
• At 3% it will produce ~$1.2 billion in fees
• Federal match will be ~$1.8 billion additional
     Quality Assurance Fee - Uses
• Reimburse hospitals at Medicare rates
• Generate funds for:
  – Electronic health records
  – Increase graduate medical education funding
  – Increase ambulatory care/disease management
  – All facilities will contribute to care of uninsured
          Recommendation 4
The state should significantly increase its
capacity and commitment to conduct
experiments in health care delivery and
funding (e.g. 1115 Waivers, funding pools,
employer subsidies).
•Adopt 3-Share Programs
•Modify EMTALA
•Family Health Waiver
         Recommendation 5
The concept of virtual care coordination
for the uninsured (including these
patients in a structured system of care)
should be developed by local
communities and by the Texas Health
and Human Services Commission.
          Recommendation 6
Health care institutions and other providers
must contribute to increasing community
based ambulatory care, which includes
integrating the latest developments in disease
management and other cost effective models
of health care delivery that seek to improve
the quality of patient care while decreasing the
cost of care.
         Recommendation 7
Texas must increase investment in the
education and training of health
professionals who will provide significant
amounts of care to the uninsured and
       Recommendation 7 (Cont.)
• 3000 More Residents Annually (Over 10
• 2000 More Nursing Graduates Annually
• Expand Medical Student Repayment
• Forgive Debt for Serving Medicaid and
  Uninsured Patients
• Fund FQHC’s and “Look A-likes”
         Recommendation 8
The Task Force recommends
implementation of an integrated approach
to school health including an emphasis
on nutrition, exercise, dental health, and
disease management of such problems
as asthma.
        Recommendation 9
Academic health institutions, state and
local governments, and communities,
foundations, and the private sector
should support the development of health
science research programs to study cost
effective health care and other
characteristics of a high quality and
efficient health system.
        Recommendation 10
Texas should adequately invest in public
health programs (including research and
community health) at the state and local
Some outcomes from the 80th Legislature
 Increased funding and improved eligibility for CHIP
 Extensive Medicaid reform including an 1115
 Support of the three share health insurance subsidy
 Committee of North Texas counties to study
  regionalization of care
 Some outcomes from the 80th Legislature
 Expanded telemedicine programs
 Pilot project on collaborative electronic health
  record between local and regional indigent care
  systems and HHSC
 Additional $38 million for GME
 Additional $9 million for nursing education
 Some outcomes from the 80th Legislature
 New nursing education initiatives
 Disease management program for diabetes in
  school aged children
 Increased requirements for student physical activity
  and assessments

 Full list of outcomes by bill number:
Now is the time for Texas to take bold
steps to address the problems associated
with the lack of health insurance
coverage and health care access in
Texas, and to protect and assure the
economic vitality and health of the state.
            For More Information
  Task Force Website

  Report Website

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